https://journals.lww.com/actjournalonline/pages/viewallmostpopulararticles.aspx
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https://journals.lww.com/actjournalonline/Fulltext/2005/10000/Creating_the_Ideal_Person_Centered_Program_and.8.aspx
There has been an explosion of activity in long-term care around creating a more person-centered or person-directed approach in philosophy and care practice. Directed initially at the institutional nursing home setting, this pioneer movement for culture change has spread to other settings of elder care and focused on major issues of program, staffing, regulation, and research. To many, dementia-capable care is the cutting edge of this culture of aging that affirms choice, dignity, independence, and meaning. High-quality, person-centered dementia care is achieved through the successful integration of program, staff, family, community, and the phyical environment. This article affirms this integrated approach and outlines 10 steps and 10 challenges in getting there.]]>Sat, 01 Oct 2005 00:00:00 GMT-05:0000130990-200510000-00008https://journals.lww.com/actjournalonline/Fulltext/2007/01000/Research_in_Practice__Montessori_Based_Dementia.9.aspx
Montessori-Based Dementia Programming® (MBDP) is a method of creating and presenting activities/interventions. The Myers Research Institute conducted several studies, each of which involved the use of MBDP in a different setting/situation. Staff members from nursing homes, adult day centers, and assisted living facilities were trained to implement MBDP, as were family members and even persons in the early stages of dementia. In addition, a Montessori-based assessment tool is being developed for use in restorative nursing for persons with moderate to advanced dementia. An overview of each study is provided, as are the findings and implications of each study.]]>Mon, 01 Jan 2007 00:00:00 GMT-06:0000130990-200701000-00009https://journals.lww.com/actjournalonline/Fulltext/2010/07000/Quality_of_Life_and_Dementia__An_Integrated_Review.6.aspx
This article presents an integrated literature review of major concepts related to quality of life (QoL) for persons with dementia and demonstrates their application to nursing care. Researchers used an integrated review of literature from 3 health care databases. The concepts related to QoL for persons with dementia are emotional states, activities of daily living, communication, cognitive functioning, and caregiver(patient perception. The review finds that QoL is independent of cognitive functioning. Nursing care of persons with dementia needs to focus on interventions that integrate the concepts demonstrated to improve quality of life.]]>Thu, 01 Jul 2010 00:00:00 GMT-05:0001300407-201007000-00006https://journals.lww.com/actjournalonline/Fulltext/2002/03040/Using_the_Environment_To_Improve_Intake_for_People.7.aspx
Physical and social environments are important but often untapped resources that can have a significant impact on the overall goals of food consumption and quality of life. The purpose of this pilot study was to examine the effect of improved lighting and table setting contrast on residents' oral intake and behaviors during meals in both assisted living and long-term care environments serving people with dementia. A 3-day calorie count, foot-candle measures, the Meal Assistance Screening Tool, and the Communication Outcome Measure of Functional Independence were administered at baseline and posttest 4 weeks later. Twenty-five residents with dementia at two long-term care facilities participated in the pilot study. After enhancing the lighting and table setting contrast, there were improvements in both oral intake and functional abilities at both facilities.]]>Tue, 01 Oct 2002 00:00:00 GMT-05:0000130990-200203040-00007https://journals.lww.com/actjournalonline/Fulltext/2004/04000/Factors_Influencing_Participation_in_Activities_in.8.aspx
The influence of cognitive impairment, functional impairment, and care setting on participation in activities has not been examined. To better understand these relationships, data were collected for 166 persons with dementia in 3 types of care settings. Residents of nursing homes and those with highest levels of cognitive and functional impairment had the lowest level of participation in staff-led activities and the greatest frequency of sleeping. In contrast, persons with mild dementia and those attending adult day centers had the highest level of participation in staff-led activities and the lowest frequency of sleeping. Implications for practice are discussed.]]>Thu, 01 Apr 2004 00:00:00 GMT-06:0000130990-200404000-00008https://journals.lww.com/actjournalonline/Fulltext/2002/03020/_Where_Is_My_Wife_and_When_Am_I_Going_Home___The.5.aspx
Communicating with persons with dementia presents a variety of challenges to professionals and family alike. This article describes the communicative strengths and deficits of persons with dementia as the disease progresses, provides a memory systems–based explanation for the range of challenging behaviors, and suggests multiple intervention techniques. Communication guidelines are offered to enhance the quality of life of those whose lives are affected by diseases that result in disordered memory.]]>Mon, 01 Apr 2002 00:00:00 GMT-06:0000130990-200203020-00005https://journals.lww.com/actjournalonline/Fulltext/2008/01000/Dementia_Care_Practice_Recommendations_for_Nursing.8.aspx
The Phase 2 Alzheimer's Association Dementia Care Practice Recommendations for Assisted Living Residences and Nursing homes are based on the latest evidence in research and the experience of care experts. To gain experiential evidence, the Association engaged experts from its Chapters and representatives of 24 national associations in a consensus-building process to translate the research into specific recommendations. Phase 2 recommendations, summarized in this article, offer guidance in ensuring physical safety and personal autonomy of residents, across 3 specific care areas: (1) resident wandering, (2) resident falls, and (3) physical restraint-free care. All recommendations are based on a person-centered approach to care, which tailors care to the abilities and changing needs of each resident. The recommendations are intended to be understandable and useful to all levels of long-term care staff and offer practical advice on strategies for improving care.]]>Tue, 01 Jan 2008 00:00:00 GMT-06:0001300407-200801000-00008https://journals.lww.com/actjournalonline/Fulltext/2004/01000/Why_Workforce_Development_Should_be_Part_of_the.10.aspx
Quality of long-term care is significantly influenced by the attributes long-term care workers bring to their jobs, the education and training they receive, and the quality of their jobs. The attitudes, values, skills, and knowledge of these workers, how they are compensated and rewarded, and the way their jobs are organized and managed, all help to determine quality of care and life outcomes. The quality of the long-term care workforce, not just the quantity, needs to be addressed in long-term care policy debates. Workforce development activities designed to increase the capacity of these individuals to participate effectively in long-term care settings should be integrated into long-term care quality improvement and assurance initiatives.]]>Thu, 01 Jan 2004 00:00:00 GMT-06:0000130990-200401000-00010https://journals.lww.com/actjournalonline/Fulltext/2004/04000/Living_With_Early_Onset_Dementia__Exploring_the.5.aspx
In contemporary society dementia is socially, culturally, and professionally constructed as an older person's disease. And although the formal definition of dementia has changed over time, its correlation with the aging process has not. Yet, as both clinical contact and the emerging literature base reveal, people younger than 65 years are also diagnosed with this condition. Drawn from encounters with younger people with dementia in the United States (N = 23) and families of younger people with dementia in the United Kingdom (N = 15), this article combines the data sets to explore both sides of the experience and the unique struggles that this group encounters. Qualitative analysis of the data has resulted in the generation of 8 inductively generated themes, namely (1) difficulties in obtaining a diagnosis; (2) issues of self-hood and self-esteem; (3) changing relationships within the family structure; (4) awareness of changes in self; (5) workforce and retirement/financial issues; (6) feelings of extreme social isolation and exclusion; (7) “off-time” dependency; and (8) lack of meaningful occupation. Using the themes as a heuristic device, the article concludes with 2 sets of evidence-based guidelines that are grouped around the issues of assessment and treatment.]]>Thu, 01 Apr 2004 00:00:00 GMT-06:0000130990-200404000-00005https://journals.lww.com/actjournalonline/Fulltext/2010/01000/Challenges_and_Strategies_for_Implementing_and.4.aspx
Evidence suggests that staff training in dementia care can improve the quality of care and the quality of life for older adults in nursing home (NH) and residential care/assisted living (RC/AL) settings. Although there is a great need for staff to be trained in dementia care, the long-term care setting poses challenges for training and uptake of new practices. This article provides a review of the published literature on dementia care staff training in NHs and RC/AL settings, the challenges faced when conducting training, and how these challenges influence the evaluation of its effectiveness. The authors examined this issue by reviewing 382 articles published between 1995 and 2009, with 25 articles meeting the review's inclusion criteria of provided staff training in dementia care, being conducted in an NH or RC/AL setting, focusing on changing overall dementia care practices (instead of single issues such as wandering or incontinence), or providing a review of relevant literature. Findings suggest that staff training is challenged by low staff attendance, lack of organizational support, and financial limitations. This review highlights the need for practical strategies to better focus and conduct staff training, such as involving community members and practitioners in the content and design of training.]]>Fri, 01 Jan 2010 00:00:00 GMT-06:0001300407-201001000-00004https://journals.lww.com/actjournalonline/Fulltext/2005/04000/Nonpharmacological_Interventions_for_Persons_With.7.aspx
Nonpharmacological approaches to the care of persons with dementia differ from pharmacological treatment in that they consider the interaction between the person, caregiver, environment, and system of care in the treatment design. Such interventions generally provide more personalized care for these individuals, addressing their needs, and considering their preferences. Nonpharmacological interventions have been used to enhance cognition, affect, and performance of activities of daily living; to reinforce a positive sense of self; and to reduce agitation/behavior problems and psychotic symptoms. This article presents a framework for implementing such interventions, provides examples from the literature of existing interventions, and argues for increased advocacy to support their research and use.]]>Fri, 01 Apr 2005 00:00:00 GMT-06:0000130990-200504000-00007https://journals.lww.com/actjournalonline/Fulltext/2010/07000/What_Matters_Most_to_Carers_of_People_with_Mild_to.4.aspx
There is little evidence on the experience and needs of carers of people with early-stage dementia and few evidence-based interventions to guide them. A qualitative research design was used to explore what matters most to carers of people with mild to moderate dementia to design individualized interventions. A descriptive phenomenological approach was used to analyze transcribed interviews. Three themes captured the essence of what matters most to 10 community dwelling carers. The findings reveal the importance of considering the unique and ongoing needs of carers throughout their journey as health care professionals strive to develop appropriate interventions.]]>Thu, 01 Jul 2010 00:00:00 GMT-05:0001300407-201007000-00004https://journals.lww.com/actjournalonline/Fulltext/2004/04000/Articulating_Environmental_Press_in_Environments.11.aspx
Alzheimer's is a progressive, degenerative disease that impairs the ability of the affected individuals to function independently. At the broadest level, there are 3 classes of interventions: pharmacologic, cognitive training, and environmental (physical and social) manipulation. The focus of this article is on this third class of interventions. For years, both long-term care facilities and families who provide care to people with dementia have worked to create physical and social environments that enhance or at least serve to maintain the ability of an individual with dementia to function as independently as possible. Unfortunately, the state of our knowledge about which strategies are most effective is hampered by the lack of a theoretical framework that specifically links physiologic changes that occur in the brains of individuals with dementia with aspects of the environment. This article, the first in a 2-part series, reports on the development of such a framework.]]>Thu, 01 Apr 2004 00:00:00 GMT-06:0000130990-200404000-00011https://journals.lww.com/actjournalonline/Fulltext/2004/04000/Adapting_Leisure_and_Creative_Activities_for.2.aspx
In the author's experience as a person with early stage dementia, the desire and need to be creative continues on despite the loss of cognitive abilities. Creative activity is important as it stimulates the mind and enhances quality of life.
The author adapted her own former hobbies and crafts, and started new ones by changing her expectations, choosing simpler projects and media, and focusing on process and pleasure rather than content. The article suggests activities and hobbies for people with increased inertia and declining cognition, and topics for recording life stories.]]>Thu, 01 Apr 2004 00:00:00 GMT-06:0000130990-200404000-00002https://journals.lww.com/actjournalonline/Fulltext/2010/10000/I_Knew_Better_____So_Why_Did_I_Do_That_.1.aspx
No abstract available]]>Fri, 01 Oct 2010 00:00:00 GMT-05:0001300407-201010000-00001https://journals.lww.com/actjournalonline/Fulltext/2004/01000/Resolving_Controversies_About_Nursing_Home.7.aspx
Major policy initiatives relevant to nursing home staffing have been stalled by controversy about the relationship of staffing to quality. The issues that have led to this controversy are reviewed, and one approach to resolve these problems is described.]]>Thu, 01 Jan 2004 00:00:00 GMT-06:0000130990-200401000-00007https://journals.lww.com/actjournalonline/Fulltext/2007/10000/Dementia_Care_as_a_Moral_Enterprise__A_Call_for_a.11.aspx
Nursing home care continues to fall short of the vision of the 1987 Omnibus Reconciliation Act's to promote quality care, in spite of expenditures to develop finer assessments and regulations. This shortcoming is partly the legacy of a hospital model never designed to support long-term residents and of a cult of “task and time” that promotes instrumental care over intersubjective person care. This article calls for a return to the sanctity of unregulated time as lived and a blurring of the distinction between “life” and “care.” This shift will transform the concept of dementia care from a commoditizedindustry to a moral enterprise designed to support the person with dementia.]]>Mon, 01 Oct 2007 00:00:00 GMT-05:0001300407-200710000-00011https://journals.lww.com/actjournalonline/Fulltext/2002/03010/Tailoring_the_Environment_of_Oral_Health_Care_to.5.aspx
This study developed and tested an intervention to promote use of preserved abilities in oral care among nursing home (NH) residents with dementia. Changes were made to environmental support for oral care and in how nursing staff provided oral care. Five NH residents participated. Changes in oral care independence and oral hygiene adequacy were assessed. Four (of 5) participants were more independent in key, “in-the-mouth” oral care tasks. Oral hygiene ratings improved 47% (±27%). All residents responded positively to the intervention. Although some staff complained initially, most embraced the changes after trying them.]]>Tue, 01 Jan 2002 00:00:00 GMT-06:0000130990-200203010-00005https://journals.lww.com/actjournalonline/Fulltext/2002/03020/Complaints_of_a_Dutiful_Daughter.9.aspx
No abstract available]]>Mon, 01 Apr 2002 00:00:00 GMT-06:0000130990-200203020-00009https://journals.lww.com/actjournalonline/Fulltext/2003/07000/Powerful_Tools_for_Caregivers__Improving_Self_Care.6.aspx
No abstract available]]>Tue, 01 Jul 2003 00:00:00 GMT-05:0000130990-200307000-00006https://journals.lww.com/actjournalonline/Fulltext/2003/07000/Does_the_Treatment_Make_a_Real_Difference__The.10.aspx
In recent years a wide variety of intervention approaches have been developed to alleviate burden and distress among family caregivers. Generally, the literature suggests that these interventions have been moderately successful in reducing outcomes such as caregiver burden, depression, anxiety, and distress. Most of the reported findings are based on statistical significance or effect size statistics. To date little emphasis has been given to the clinical significance or practical relevance of intervention outcomes. The objectives of this paper are to (1) define the construct of clinical significance and review existing methods for measuring clinical significance, (2) discuss strategies for maximizing clinical significance, and (3) outline other issues such as cost-effectiveness that need to be considered within intervention research. Our overall goal is to extend our understanding of methods for evaluating the effectiveness of interventions to improve the quality of intervention research.]]>Tue, 01 Jul 2003 00:00:00 GMT-05:0000130990-200307000-00010https://journals.lww.com/actjournalonline/Fulltext/2002/03020/Music_as_Communication.6.aspx
Research has shown that when used correctly, music can exert an influence on mood, behavior, speech, interaction with others, and ability to perform activities of daily living. This article examines the use of music with persons with dementia and offers practical recommendations for the development and implementation of music programs in residential facilities and other programs serving these individuals.]]>Mon, 01 Apr 2002 00:00:00 GMT-06:0000130990-200203020-00006https://journals.lww.com/actjournalonline/Fulltext/2004/04000/A_Feeding_Abilities_Assessment_for_Persons_With.6.aspx
This article describes the reliability and validity of a Feeding Abilities Assessment (FAA) that assesses abilities threatened by ideational apraxia in persons with dementia. A sample of 259 residents (156 with dementia and 103 controls) across 4 long-term care sites was used. The results (Pearson's r, Kappa, and Cronbach's alpha coefficients > .80) supported the FAA's reliability. The content validity index was 0.80. The construct validity was indicated by statistically significant differences on the mean scores between the 2 groups (t(155)= −10.10, P < .01). The FAA can systematically guide the day-to-day mealtime activities of caregivers.]]>Thu, 01 Apr 2004 00:00:00 GMT-06:0000130990-200404000-00006https://journals.lww.com/actjournalonline/Fulltext/2002/03010/Observed_Affect_in_a_Dementia_Day_Center__Does_the.14.aspx
This intrinsic case study explores the relationship between the physical setting and observed affect in participants of a dementia-capable adult day center. It is found that the setting in which the affect is observed has a small but statistically significant relationship to the enduring affects of engagement and awareness and also to the more fleeting affect of pleasure, even when one considers the level of activity engagement and degree of social interaction in which those participants are involved. It is suggested that the physical setting may play an even more important role in facilitating positive quality of life assessments (such as pleasure and engagement) than it plays in mitigating negative behaviors.]]>Tue, 01 Jan 2002 00:00:00 GMT-06:0000130990-200203010-00014https://journals.lww.com/actjournalonline/Fulltext/2003/10000/Community_Caregiving.6.aspx
Family caregivers play a vital role in the care of the impaired elderly and generally need a great deal of support, assistance, and understanding from their families and friends and from the formal care system. The majority of caregivers are spouses of the patients, and generally elderly themselves. Spouse-caregivers often take over tasks traditionally performed by their husbands or wives, and curtail other activities to do so. Many elderly spouse-caregivers become socially isolated. Interventions for caregivers should take into account cultural norms and gender differences in role expectations. Psychosocial interventions for caregivers can improve caregiver knowledge of the illness and ability to provide care, change their understanding and appraisal of their relative's behavior, and alleviate depression and burden. The New York University (NYU) caregiver intervention includes individual and family counseling, support group participation, and counseling on demand (“ad hoc” counseling) and takes into account the diversity and variability in caregiver problems and the need for counseling and support for the entire course of the illness. The NYU intervention improves knowledge of the disease, increases emotional support for the caregiver, and assists caregivers in development of caregiving management skills. The long-term results of the study support the effectiveness of the intervention in maintaining the mental health of caregivers and helping them keep their ill spouses at home.]]>Wed, 01 Oct 2003 00:00:00 GMT-05:0000130990-200310000-00006https://journals.lww.com/actjournalonline/Fulltext/2005/10000/Alzheimer_s_Disease_Experienced.2.aspx
For the third time, Richard Taylor shares some of his thoughts with our readers. Diagnosed 3 years ago with early-onset, early-stage Dementia of the Alzheimer's type, he started to write to himself in an effort to better understand what was going on inside of him. This is what one reader of his self-explorations wrote to him:
Have you ever had an “aha moment” when the light bulb goes on? Well, after reading your essay, I've had my moment and now I really feel stupid. How could I not have seen this?I know that I'm a very strong personality. I'm usually in control and when I'm not in control, I'm definitely the co-pilot in life. I've been looking at my dad from my perspective and from society's perspective.It never dawned on me to look at it from his perspective. I need to sit down and really talk with him on Sunday when I see him (I know that I haven't had many deep conversations with him in the last year). My mom mentioned that he knows he can't remember things and that he gets frustrated. I'm guessing he's downright scared. And the pushing that Ma and I have been doing probably hasn't made it any better and most probably made it worse. And my mom needs to stop hovering over him. Give him a little breathing room. I need to stop looking at him with society's eyes and the daughter's eyes of a man who did everything and anything—I just need to look at him with love.
Readers and carers are invited to share in more of Richard's thoughts and experiences and reflect on whether their interactions with persons with Alzheimer's disease matches/ignores/clashes with the needs that Richard finds within himself.
On this note, conversations that we would never think to entertain about various diseases occur every day in the households of individuals diagnosed with Dementia of the Alzheimer's type. Sometimes they take place in front of individuals with the disease! The following are some remarks that still ring in Richard's ears.]]>Sat, 01 Oct 2005 00:00:00 GMT-05:0000130990-200510000-00002https://journals.lww.com/actjournalonline/Fulltext/2010/10000/Communication_Techniques_for_Nonverbal_Individuals.2.aspx
No abstract available]]>Fri, 01 Oct 2010 00:00:00 GMT-05:0001300407-201010000-00002https://journals.lww.com/actjournalonline/Fulltext/2005/10000/Research_Informs_Design__Empirical_Findings.6.aspx
This study investigated the impact of carpet texture and pattern on walking time and stability of 107 persons with Alzheimer's disease. Respondents walked seven 4 × 15-ft carpet paths representing a range in motif size and value contrast. Walks were timed and videotaped for analysis. Significant differences emerged in walk time due to texture and pattern and in number of incidents due to pattern. In texture, slower walk times were associated with the pile texture. Patterns receiving the shortest walk times and lowest number of incidents in each texture were the patterns having the smallest motifs and lowest contrast.]]>Sat, 01 Oct 2005 00:00:00 GMT-05:0000130990-200510000-00006https://journals.lww.com/actjournalonline/Fulltext/2004/10000/Reaching_the_Living_Echo__A_New_Paradigm_for_the.10.aspx
This article focuses on the need for a new paradigm for the delivery of spiritual care in the lives of persons living with Alzheimer's disease. This need is based on the inability of commonly practiced traditional methods, which are rational and cognitive, to reach the soul of the person with the disease because of the effects of Alzheimer's disease on the person. These effects include a shift in experience of time. The hypothesis is presented that persons with Alzheimer's disease have an opportunity to experience the Divine in a mystical way that can allow for spiritual growth]]>Fri, 01 Oct 2004 00:00:00 GMT-05:0000130990-200410000-00010https://journals.lww.com/actjournalonline/Fulltext/2007/07000/Health_Effects_of_Caregiving__Studies_of_Helping.10.aspx
Previous research suggests that spousal caregiving causes health problems in the caregiver, including increased mortality risk. Yet, this conclusion is based on studies that do not measure helping behavior, but assume that caregiving must occur if someone in a marriage has a health problem. In this article, I highlight the need for research that disentangles the competing, and perhaps contradictory, psychosocial factors inherent in the caregiving experience. I review studies that suggest there are health benefits associated with helping others and describe the implications of a new theory of close relationships for understanding the caregiving experience.]]>Sun, 01 Jul 2007 00:00:00 GMT-05:0001300407-200707000-00010